Introduction
Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a critical component of multi-system metabolic dysfunction and has emerged as a significant global health issue. A growing body of evidence suggests that intake of sugar and its substitutes is linked to cardiometabolic and kidney diseases. While sugar-sweetened beverages (SSBs) and low- or non-sugar-sweetened beverages (LNSSBs) are widely consumed, their associations with liver health outcomes remain uncertain.
Aims & Methods
In this prospective cohort study of 103,251 UK Biobank participants free of baseline liver disease, we investigated the associations between SSBs and LNSSBs intake and the risk of incident MASLD and liver-related mortality. Beverage consumption was assessed through multiple 24-hour dietary questionnaires. The primary outcome was incident MASLD, and secondary outcomes included liver-related mortality and liver fat content measured by MRI- derived proton density fat fraction. Multivariable Cox regression, linear models, stratified analyses, restricted cubic spline, sensitivity analyses, and beverage substitution analyses were employed.
Results
Over a median 10.3-year follow-up, 949 participants developed MASLD, and 103 died from liver-related causes. Higher intake of LNSSBs (>330 g/day) and SSBs (>330 g/day) were associated with elevated MASLD risk (HR: 1.597 and 1.502, respectively; both p < 0.01). LNSSBs consumption also increased liver-related mortality risk in a dose-dependent manner, while no significant association was observed for SSBs. Both beverages were positively associated with liver fat content. Replacing 330 g/day of either beverage with water significantly reduced MASLD risk by 14.7% (SSBs) and 13.5% (LNSSBs), whereas substitution between LNSSBs and SSBs showed no difference in risk.
Conclusion
High intake of either SSBs or LNSSBs is significantly associated with an increased risk of MASLD, with LNSSBs additionally linked to a higher risk of liver-related mortality. Water substitution may offer benefits. These findings support limiting the intake of both SSBs and LNSSBs as part of comprehensive prevention strategies targeting cardio-renal-liver-metabolic dysfunction.